Basic Information
| Provider Information | |||||||||
| NPI: | 1316485246 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SA'ENA | ||||||||
| FirstName: | QUINCY | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6210 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | NM | ||||||||
| PostalCode: | 874996210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5056092258 | ||||||||
| FaxNumber: | 5056092259 | ||||||||
| Practice Location | |||||||||
| Address1: | 656 W MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | NM | ||||||||
| PostalCode: | 874015968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5056092990 | ||||||||
| FaxNumber: | 5056092996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2017 | ||||||||
| LastUpdateDate: | 01/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS16377 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | A-2429-20 | NM | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.